Gay Mobile Apps and the Evolving Virtual Risk Environment: A
Cross-Sectional Online Survey among Men who have Sex with
Men in China
Weiming Tang1,2,3,*, John Best1,2,4,*, Ye Zhang1,2,3, Fengying Liu2,3, Lai Sze Tso1,3,*, Shujie Huang2,3, Bin Yang2,3, Chongyi Wei5, and Joseph D. Tucker1,3
1University of North Carolina Project-China, No. 2 Lujing Road, Guangzhou, China, 510095
2Guangdong Provincial Centres for Skin Diseases and STI Control, No. 2 Lujing Road,
Guangzhou, China, 510095
3SESH Global, No. 2 Lujing Road, Guangzhou, China, 510095
4School of Medicine, University of California, San Francisco, 550 16th Street San Francisco CA,
USA 94158
5Department of Epidemiology and Biostatistics & Global Health Sciences, University of California,
San Francisco, 550 16th Street San Francisco CA, USA 94158
Abstract
Objectives—The expansion of gay sex-seeking application (gay app) use among men who have sex with men (MSM) may create new virtual risk environments that are associated with STI transmission. The goals of this study were to compare sexual behaviors between gay app users and non-users, and to describe sexual behaviors among gay app users in China.
Methods—In October 2014, we recruited MSM from three Chinese gay websites. Data on socio-demographics, sexual behaviors and gay app use were collected. Logistic regressions were used to compare gay app users to non-app users and to identify factors associated with condomless sex among gay app users.
Results—Of the 1,424 participants, most were less than 30 years old (77.5%), single (83.8%), and self-identified as gay (72.9%). Overall, 824 (57.9%) used gay apps for partner-seeking in the last six months. Among gay app users, 36.4% met their last partner within 24 hours of first message exchange through gay apps, and 59.0% negotiated condom use before in-person meeting. Compared to non-users, gay app users reported engaging in more condomless sex in the last six
Correspondence: Joseph D.Tucker,, University of North Carolina Chapel Hill Project-China, No. 2 Lujing Road, Guangzhou, China,
510095, [email protected].
*Contributed equally to this research and are co-first authors.
Conflicts of Interest: No conflicts of interest. For the remaining authors none were declared.
The Corresponding Author has the right to grant on behalf of all authors and does grant on behalf of all authors, an exclusive licence (or non exclusive for government employees) on a worldwide basis to the BMJ Publishing Group Ltd to permit this article (if accepted) to be published in STI and any other BMJPGL products and sub-licences such use and exploit all subsidiary rights, as set out in our licence http://group.bmj.com/products/journals/instructions-for-authors/licence-forms
HHS Public Access
Author manuscript
Sex Transm Infect
. Author manuscript; available in PMC 2017 December 09.Published in final edited form as:
Sex Transm Infect. 2016 November ; 92(7): 508–514. doi:10.1136/sextrans-2015-052469.
A
uthor Man
uscr
ipt
A
uthor Man
uscr
ipt
A
uthor Man
uscr
ipt
A
uthor Man
uscr
months (aOR=1.52, 95% CI 1.19–1.94) and more group sex (aOR=1.49, 95% CI 1.02–2.18). Negotiating about condom use before in-person meeting was positively associated with condom use with partners met through gay apps (aOR=1.83, 95% CI 1.29–2.60).
Conclusion—Gay apps are linked to risky sexual behaviors and may foster a virtual risk environment for STI transmission among Chinese MSM. App-based interventions could target young gay man and facilitate condom negotiation.
Keywords
Gay men; Sexual Behavior; HIV; China
Introduction
Key populations, which include men who have sex with men (MSM), transgender individuals, persons who inject drugs, sex workers and people in prisons and other closed (institutional) settings, account for more than half of all new HIV infections in many low and middle-income countries (LMICs).1 Many MSM in LMIC contexts face harsh local sanctions and cultural stigma and, for a number of reasons, turn to MSM specific
smartphone-based sex-seeking applications (gay apps) to find new sex partners.2 Gay app use around the world has rapidly expanded over the past five years.3
Gay app use and its associated patterns may influence sexual risk behaviors. Gay apps’ geospatial technology facilitates rapid sex partner identification regardless of time or location. Gay app use has been associated with an increased number of sex partners4 and condomless sex in the United States.4–6 However, other data suggests that sex-seeking gay apps and other gay specific apps may increase social support7, facilitate HIV service delivery and decrease risk behaviors.8–10
Although a number of studies have examined gay app use and sexual behaviors in high-income settings, there is limited data from low and middle-high-income settings.2 China presents a unique opportunity to examine the influence of gay app use because the adoption of gay app use has been relatively widespread2 and swift.11 Virtually nonexistent five years ago, approximately 40% of gay men reported using gay apps to find sex partners in 2013 and the largest locally developed gay app reported approximately seven million new users last year alone.11
Despite the importance of gay apps, we have very limited knowledge on specific patterns of gay app use and their relationship with high-risk sexual behaviors. Therefore, we conducted a cross-sectional survey among Chinese MSM to: 1) compare sexual risk behaviors between gay app users and non-users; 2) describe specific patterns of gay app use among users; and 3) identify factors associated with condomless anal sex among gay app users.
Materials and Methods
We conducted an online survey in September-October 2014 among Chinese MSM. We hosted the survey on three large popular gay web portals in Northern China (http://
www.danlan.org), Southern China (http://www.yntz.net), and Eastern China (http://
A
uthor Man
uscr
ipt
A
uthor Man
uscr
ipt
A
uthor Man
uscr
ipt
A
uthor Man
uscr
www.jstz.org). These web portals provide MSM-specific news, social networking opportunities, and advertisements. These three web portals were selected because of their geographically diverse users and high web traffic. Together they reach an estimated 90,000 unique daily users according to internal analytics.
Survey development and recruitment
We interviewed MSM and other key stakeholders to inform development of our online survey. In addition, our draft survey was reviewed by local MSM who had previously participated in online surveys, local community-based organization (CBO) leaders and staff, social media experts, and physicians and public health experts.1213 Prior to final survey launch, we piloted the survey with 144 individuals on one of the web portals (data not included in final analysis). We followed a checklist for reporting results of Internet e-surveys (CHERRIES) throughout the process to improve quality and reporting of our web survey.14 Participants were recruited via banner links on each web portal homepage as well as an announcement sent to registered users. After clicking the banner, participants were directed to the informed consent and eligibility screening questions. Eligibility criteria included being assigned male sex at birth, 16 years of age or older, engaged in anal or oral sex with a man in the previous year, willing to provide their cell phone number and completed the informed consent process. At the end of our survey was an additional section investigating the efficacy of HIV testing promotion messages. Participants eligible for the additional section (never tested for HIV) received a small (10 USD) phone card reimbursement but were not aware of eligibility criteria before the study. The phone number was used to both screen for duplicates as well as provide reimbursement to eligible participants.
Measures—Socio-demographic information collected in the survey included age, occupation, living situation, marital status, education, and income. Participants were asked about their sexual orientation as well as the gender of their current sexual partners, number of sexual partners in the last six months, and history of receptive or insertive condomless anal intercourse with male partners and condomless sex with female partners. They were also asked about participation in group sex and commercial sex.
Participants were asked whether they used gay apps to find sex partners in the last six months. If participants reported any use of gay apps to find sex partners in the last six months, they were categorized as gay app users, while others were categorized as non-users. Those who used gay apps were asked about behaviors with sex partners they met through the applications, including number of partners, condom use, time from initial conversation to in-person meeting, and location of meeting. They were also asked whether they negotiated condom use and discussed HIV status with their sex partner before meeting via gay apps. If participants did not negotiate condom use via gay apps, they were asked whether condom negotiation occurred in-person. In our study, gay app partners were defined as male partners that were found via gay apps.
Statistical Analysis
Descriptive analysis was performed to describe socio-demographics, risk behaviors, and patterns of gay app use. Univariate and multivariate logistic regression were used to compare
A
uthor Man
uscr
ipt
A
uthor Man
uscr
ipt
A
uthor Man
uscr
ipt
A
uthor Man
uscr
gay app users and non-users, while demographic characteristics, including age, residence, education, marital status, and income were adjusted for in the multivariate logistic regression models. Logistic regressions (univariate and multivariate) were also used to compare gay app users who did not use a condom during last anal intercourse with partners found through gay app and those who did, adjusting for age, residence, education, marital status and income in the multivariate logistic regression models.
Ethical Statement
Ethics review committees in China (Guangdong Provincial Center for Skin Diseases and STI Control), and the United States (University of North Carolina at Chapel Hill (14–1685) and the University of California, San Francisco (14–14877)) approved the study prior to launch.
Results
Study participants
In the two months of survey availability, the links to the survey were clicked a total of 5,339 non-unique times. Of these clicks, 2,192 withdrew before screening for eligibility (1,536 withdrew prior to reading the consent form, and 656 did not sign the consent form). In addition, 1,328 of those who clicked did not meet the eligibility criteria and 395 were excluded due to duplicates (same phone number). Overall, a total of 1,424 eligible MSM from 290 cities within 32 provinces finished the online survey.
Demographics and behaviors
Of the 1424 participants, 14.5% (206) were less than 20 years old, 63.1% (898) were between 20 and 29 years old, and the majority (88.9%) resided in an urban area. In addition, 68.0% (969) had a college degree, while another 6.0% (86) had a graduate degree or higher. Over four-fifths (83.8%) of participants were never married, two-fifths (41.3%) were students, and about three quarters (74.0%) had an annual income over $3000USD (Table 1).
Among survey participants, 48.5% (691) reported that they currently have a main partner and 29.1% (414) had ever engaged in vaginal or anal sex with women. Among those who ever engaged in sex with women, 44.0% (182/414) had reported condomless sex with women in the last six months. 29.6% (421) of participants reported engaging in condomless anal sex with their last male partner in the last six months. When engaging in anal
intercourse, 36.8% (524) of participants preferred insertive, 43.6% (621) preferred receptive, and the rest 19.6% (279) had no preference.
Patterns of gay app users
In the last six months, 824 (57.9%) participants used a gay app to seek sex partners. Among gay app users, 337 (40.9%) also found partners using other online media. Of the gay app users, 334 (40.5%) started to use gay apps within the last year, and 398 (48.3%) have been using gay apps for one to three years (Table 2).
About one-third (32.3%) of gay apps users met four or more sex partners via gay apps in the last six months. Approximately one quarter (23.7%) reported six or more receptive anal sex
A
uthor Man
uscr
ipt
A
uthor Man
uscr
ipt
A
uthor Man
uscr
ipt
A
uthor Man
uscr
acts with partners met through a gay app in the last six months, and about one quarter (25.5%) had six or more insertive anal sex acts with partners met through gay app in the last six months.
For the last gay app partner, 36.4% reported meeting in person within 24 hours of initiating contact on a gay app, and 38.5% met within 2–7 days. About half of them had sex in a hotel.
Before meeting in person, 59.0% of participants reported negotiating condom use with their last gay app partners. Among those who did not discuss condom use via gay app, 32.3% talked about condom use in person. About one quarter (25.4%) gay app users did not use condom during last anal sex with the last partner met through gay app. Only one-third of gay app users discussed HIV status with their last gay app partner before meeting in person.
Factors associated with gay app use
Participants who had never engaged in sex with women were more likely to be gay app users (crude OR=1.85, 95% CI 1.47–2.32). Compared to non-users, gay app users were more likely to have condomless anal intercourse in the last six months, with crude OR of 1.31 (95% CI 1.04–1.66) (Table 3).
After adjusting for age, residence, education, marital status and income we found gay orientation, never having engaged in sex with women, and reported condomless anal intercourse in the last six months were still positively associated with gay app use, with adjusted ORs of 1.30 (95% CI 1.01–1.66), 1.49 (95% CI 1.12–1.96), and 1.52 (95% CI 1.19–1.94), respectively. In addition, gay app users were more likely report engaging in group sex, with adjusted OR of 1.49 (95% CI 1.02–2.18) (Table 3).
After adjusting for age, residence, education, marital status and income, we found users who had condomless anal intercourse with last gay app partner were more likely to report more than 20 receptive anal sex acts with gay app partners in the last six months (aOR 2.49, 95% CI 1.27–4.87) than users who used condom consistently with last gay app partner.
Negotiating condom use before meeting in person was associated with reporting condom use during last anal sex with gay app partner (aOR= 1.83, 95% CI 1.29–2.60). However, no correlation was identified between in-person condom negotiation and subsequent condom use (aOR= 0.84, 95% CI 0.58–1.21). In addition, having sex at home or at venues were also associated with a higher likelihood of reported condomless anal intercourse during last anal sex with the last gay app partner, compared to having sex at hotels, with adjusted ORs of 1.65 (95% CI 1.15–2.38) and 1.92 (95% CI 0.99–2.60), respectively (Table 4).
We found a differential pattern of behavior based upon time to meeting partner on the gay application. Individuals who met their partners in less than one week after initiating conversations on the application were more likely to report multiple partners in the last six months (78.3%) when compared to individuals who took greater than one week (78.3 vs. 56.5%, p<0.05, Table 5). We also found 28.4% gay app users who met their partners in-person within one week after online meeting asked the serostatus of their last gay app partners, versus 47.8% (P<0.05) for those meeting partners longer than one week after online meeting (Table 5).
A
uthor Man
uscr
ipt
A
uthor Man
uscr
ipt
A
uthor Man
uscr
ipt
A
uthor Man
uscr
Sexual behaviours based on the means of meeting partners were also compared (Appendix A). Rates of reported condom use with last sexual partner met via gay application were similar to those of last partner met via websites. There were higher reported rates of condomless sex with last partners met via in-person venues (Appendix A).
Discussion
The increasing use of gay apps among Chinese MSM reduces many barriers for MSM to meet new sex partners. Most of the literature about gay app use among MSM has come from high-income contexts.215 Our study extends the existing literature by recruiting participants from many big cities throughout China, not requiring in-person disclosure of sexual
orientation to participate, and gathering detailed gay app data. Our findings indicate that gay app users have more high-risk behaviours than non-users, which may correlate with
increased disease transmission among gay app users.
We found that gay app users were more likely to report condomless sex. This was consistent with some literature16, but contrasted our earlier research in China.2 A potential reason for this contrast is that the population of gay app users is evolving and higher numbers of men with high-risk behaviors have become users. For example, in 2013, only about 40% MSM reported that they were gay app users, while this proportion increased to 58% in 2014. China’s most popular gay app has grown to 15 million users in only two years.11 Another potential reason is the behaviors of the users may also change over time. Perhaps users exercised a greater degree of caution when first using the application and participate in higher risk behaviors as app use becomes normalized within the community. We did not collect information on sexual behaviors before and after the use of gay apps. Future studies should investigate temporal behavior changes among app users.
Our study suggests that men who reported negotiating condom use through gay apps were more likely to use a condom. This finding is consistent with literature that reports enhanced communication about condom use is associated with condom use.1718 We did not find any relationship between in-person condom negotiation and subsequent condom use, suggesting the importance of condom negotiation on gay apps. The low rate of negotiation about condom use may further increase the chance of condomless anal sex and in turn increase the transmission of HIV and other STIs. Coordinating efforts with gay app companies to encourage regular discussion about condom use or other harm reduction behaviors before in-person meetings might be useful. Several gay app companies have taken a more public health-focused approach (hornet), but have not been as effective in drawing and retaining gay app users over time as conventional gay apps in China.
Our results indicated that the time from online meeting to in-person meeting was often only a few hours. The short duration between online meeting and in-person meeting may limit communication between gay app users in regards to discussing HIV sero-status and condom use. Shorter duration between meeting online and in person was associated with less discussion about HIV status. The short duration between online meeting and in-person meeting may also facilitate increased number of partners for gay app users. We found evidence for this trend in our study, finding that a higher proportion of gay app users who
A
uthor Man
uscr
ipt
A
uthor Man
uscr
ipt
A
uthor Man
uscr
ipt
A
uthor Man
uscr
met their last gay app partners in-person within one week of initiating conversation (vs. >1 week) have two or more gay app partners in last six months. Combined with the higher condomless anal intercourse rate, these features may foster a virtual environment for gay app users, and in turn facilitate HIV transmission.
Our study has several limitations. First, we only recruited online gay men who tend to be younger and more highly educated19 compared to non-online gay men in China. However, national data20 suggest that young gay men have a disproportionate burden of syphilis and HIV. Second, all the behaviors measured in our study were based on self-report. This may result in a social desirability reporting bias, especially given stigma surrounding HIV and MSM behaviours. However, our survey did not collect personal information except participants’ cell phone numbers for reimbursement. Third, a large number of MSM who clicked the survey link withdrew before being screened for eligibility, which may have resulted in selection bias. Fourth, the failure to distinguish between partner types – and particularly to distinguish between whether they were in a monogamous ongoing
relationship or not is also an important limitation of our study. A recent study of Hong Kong app users found relationship status to be a predictor of condom use.21 In addition, our survey recruited online MSM from across the country and did not include populations who do not use the Internet or MSM web portals. However, there is widespread Internet use across China and previous studies have not found a difference in reported condom use between online and non-online MSM.22 Finally, this is a cross-sectional survey and cannot identify causality. Regardless, our study identifies app users as a population of increased sexual risk for future health campaigns.
Gay apps have become a widely accepted part of gay life in China. Our survey data suggest that gay apps foster a virtual environment that is associate with to condomless sex and other high-risk behaviours in China. We found specific features and patterns of gay app use that were correlated with higher rates of risky sexual behaviors. Longitudinal prospective studies that targets how gay app use shifts behavioral norms of MSM are needed. In addition, policy makers, researchers and gay app companies should work together to explore the role of gay apps in facilitating HIV and other STI transmission among MSM. Further implementation research on using the gay apps of MSM may be useful for preventing STI and for promoting other STI services such as partner services.
Supplementary Material
Refer to Web version on PubMed Central for supplementary material.
Acknowledgments
Source of Funding: Joseph D. Tucker and Chongyi Wei are receiving grants (NIAID 1R01AI114310-01,
R00MH093201 and FIC 1D43TW009532-01) from National Institutes of Health, Weiming Tang and Fengying Liu is receiving grants (5R25TW009340) from UJMT Fogarty Fellowship, and John Best is receiving grants
(R25TW0093) from UJMT Fogarty Fellowship.
We thank all the study participants and staff members at SESH Global, Danlan, Jiangsu Tongzhi, Yunnan Tongzhi and the Guangdong Provincial Centers for Skin Diseases and STI Control who contributed. We thank Dr. Heping Zheng, Dr. Peter Vickerman, Dr. Paul Volberding, Dr. Kate Mitchell, Dr. Kate Muessig, Larry Han, Dee Poon, Gang Meng for their support. A complete list of acknowledgements is available in the protocol.
A
uthor Man
uscr
ipt
A
uthor Man
uscr
ipt
A
uthor Man
uscr
ipt
A
uthor Man
uscr
References
1. Organization WH. Consolidated Guidelines on HIV preventIon, dIagnosIs, treatment and care for key populatIons. 2014 Jul.
2. Bien CH, Best JM, Muessig KE, et al. Gay Apps for Seeking Sex Partners in China: Implications for MSM Sexual Health. AIDS and Behavior. 2015:1–6. [PubMed: 24668254]
3. Kirby T, Thornber-Dunwell M. Phone apps could help promote sexual health in MSM. The Lancet. 2014; 384(9952):1415.
4. Holloway IW, Pulsipher CA, Gibbs J, et al. Network Influences on the Sexual Risk Behaviors of Gay, Bisexual and Other Men Who Have Sex with Men Using Geosocial Networking Applications. AIDS and Behavior. 2015:1–11. [PubMed: 24668254]
5. Grosskopf NA, LeVasseur MT, Glaser DB. Use of the internet and mobile-based “apps” for sex-seeking among men who have sex with men in New York City. American journal of men's health. 2014; 8(6):510–520.
6. Winetrobe H, Rice E, Bauermeister J, et al. Associations of unprotected anal intercourse with Grindr-met partners among Grindr-using young men who have sex with men in Los Angeles. AIDS care. 2014; 26(10):1303–1308. [PubMed: 24754563]
7. Hightow-Weidman LB, Muessig KE, Pike EC, et al. HealthMpowerment. org Building Community Though a Mobile-Optimized, Online Health Promotion Intervention. Health Education & Behavior. 2015 1090198114562043.
8. Holloway IW, Rice E, Gibbs J, et al. Acceptability of smartphone application-based HIV prevention among young men who have sex with men. AIDS and Behavior. 2014; 18(2):285–296. [PubMed: 24292281]
9. Muessig KE, Pike EC, Fowler B, et al. Putting prevention in their pockets: developing mobile phone-based HIV interventions for black men who have sex with men. AIDS patient care and STDs. 2013; 27(4):211–222. [PubMed: 23565925]
10. Cornelius JB, Cato M, Lawrence JS, et al. Development and pretesting multimedia HIV-prevention text messages for mobile cell phone delivery. Journal of the Association of Nurses in AIDS Care. 2011; 22(5):407–413. [PubMed: 21256053]
11. Watt LPA. Chinese gay dating app grows to 15 million users. US NEWs. 2014
12. Chow EP, Tucker JD, Wong FY, et al. Disparities and risks of sexually transmissible infections among men who have sex with men in China: a meta-analysis and data synthesis. PloS one. 2014; 9(2):e89959. [PubMed: 24587152]
13. Bien CH, Muessig KE, Lee R, et al. HIV and Syphilis Testing Preferences among Men Who Have Sex with Men in South China: A Qualitative Analysis to Inform Sexual Health Services. 2015 14. Eysenbach G. Improving the quality of Web surveys: the Checklist for Reporting Results of
Internet E-Surveys (CHERRIES). Journal of medical Internet research. 2004; 6(3):e34. [PubMed: 15471760]
15. Chaudhary SC, Sawlani KK, Arora R, et al. Native aortic valve fungal endocarditis. BMJ Case Reports. 2013; (007144)
16. Rice E, Holloway I, Winetrobe H, et al. Sex risk among young men who have sex with men who use Grindr, a smartphone geosocial networking application. Journal of AIDS & Clinical Research. 2012
17. Wilson PA, Díaz RM, Yoshikawa H, et al. Drug use, interpersonal attraction, and communication: situational factors as predictors of episodes of unprotected anal intercourse among Latino gay men. AIDS and Behavior. 2009; 13(4):691–699. [PubMed: 18985447]
18. Noar SM, Carlyle K, Cole C. Why communication is crucial: Meta-analysis of the relationship between safer sexual communication and condom use. Journal of health communication. 2006; 11(4):365–390. [PubMed: 16720536]
19. Han L, Bien CH, Wei C, et al. HIV self-testing among online MSM in China: implications for expanding HIV testing among key populations. JAIDS Journal of Acquired Immune Deficiency Syndromes. 2014; 67(2):216–221. [PubMed: 24991972]
A
uthor Man
uscr
ipt
A
uthor Man
uscr
ipt
A
uthor Man
uscr
ipt
A
uthor Man
uscr
20. Gu WM, Yang Y, Wang QZ, et al. Comparing the performance of traditional non-treponemal tests on syphilis and non-syphilis serum samples. International Journal of STD & AIDS. 2013; 24(12): 919–925. [PubMed: 23970626]
21. Yeo TED, Ng YL. Sexual risk behaviors among apps-using young men who have sex with men in Hong Kong. AIDS care. 2015:1–5.
22. Zhang D, Bi P, Lv F, et al. Differences between Internet and community samples of MSM: implications for behavioral surveillance among MSM in China. AIDS care. 2008; 20(9):1128– 1137. [PubMed: 18825519]
A
uthor Man
uscr
ipt
A
uthor Man
uscr
ipt
A
uthor Man
uscr
ipt
A
uthor Man
uscr
Key Messages
➢ Gay sex-seeking applications (gay apps) are widely used by Chinese Men who have sex with men (MSM) recruited online;
➢ Compared to non-users, gay app users reported engaging in more condomless sex in the last six months and reported engaging in more group sex;
➢ Gay apps users who had more receptive sex and did not negotiate condom use before meeting engaged in more condomless sex.
A
uthor Man
uscr
ipt
A
uthor Man
uscr
ipt
A
uthor Man
uscr
ipt
A
uthor Man
uscr
A
uthor Man
uscr
ipt
A
uthor Man
uscr
ipt
A
uthor Man
uscr
ipt
A
uthor Man
uscr
ipt
T ab le 1Demographics and beha
viors of participants from an online surv
ey in China, 2014 (N=1424)
Gay app users
(n=824) Non-users (n=600) T otal (N=1424) Fr equency P er cent Fr equency P er cent Fr equency P er cent Characteristics Age <20 132 16.0 74 12.3 206 14.5 20–29 548 66.5 350 58.3 898 63.1
30 and abo
v e 144 17.5 176 29.3 320 22.5 Residency Urban 752 91.3 514 85.7 1266 88.9 Rural 72 8.7 86 14.3 158 11.1 Education
High school or belo
w 186 22.6 183 30.5 369 25.9 Colle ge / Bachelors 588 71.4 381 63.5 969 68.0
Masters or PhD
50 6.1 36 6.0 86 6.0 Marital Status Single, ne v er married 732 88.8 462 77.0 1194 83.8 Eng
aged / Married
60 7.3 98 16.3 158 11.1 Di v orced / W ido wed 32 3.9 40 6.7 72 5.1 Student Y es 362 43.9 226 37.7 588 41.3 No 462 56.1 374 62.3 836 58.7 Y
early Income ($, USD)
3000 and belo
A
uthor Man
uscr
ipt
A
uthor Man
uscr
ipt
A
uthor Man
uscr
ipt
A
uthor Man
uscr
ipt
Gay app users
(n=824) Non-users (n=600) T otal (N=1424) Fr equency P er cent Fr equency P er cent Fr equency P er cent
Characteristics Transgender indi
viduals Y es 31 3.8 30 5.0 61 4.3 No 793 96.2 570 95.0 1363 95.7 Curr ently ha v
e a main
sexual partner Y es 409 49.6 282 47.0 691 48.5 No 415 50.4 318 53.0 733 51.5 Ev
er engaged in v
aginal
or anal sex with w
omen Y es 195 23.7 219 36.5 414 29.1 No 629 76.3 381 63.5 1010 70.9
Engaged in condomless sex with w
omen in the
last six months
* Y es 78 40.0 104 47.5 182 44.0 No 117 60.0 115 52.5 232 56.0
Engaged in condomless anal sex with last male partner men in the last six months
Y es 263 31.9 158 26.3 421 29.6 No 561 68.1 442 73.7 1003 70.4 Pr eferr
ed sexual r
ole
during anal sex with man
Inserti v e 282 34.2 242 40.3 524 36.8 Recepti v e 384 46.6 237 39.5 621 43.6 No preference 158 19.2 121 20.2 279 19.6
Engaged in gr
oup sex in
the last 12 months
Y es 90 10.9 51 8.5 141 9.9 No 734 89.1 549 91.5 1283 90.1
Engaged in commer
cial
sex in the last 12 months
Y es 53 6.4 29 4.8 82 5.8 No 771 93.6 571 95.2 1342 94.2 Self-r
eported HIV status
# T ested, positi v e 31 7.4 37 13.1 68 9.7 T ested, ne g ati v e 358 85.2 211 74.6 569 81.0 T
ested, no result
31 7.4 35 12.4 66 9.4
Had sex with men in the last six months
A
uthor Man
uscr
ipt
A
uthor Man
uscr
ipt
A
uthor Man
uscr
ipt
A
uthor Man
uscr
ipt
* for participants who had se
x with w
omen only;
A
uthor Man
uscr
ipt
A
uthor Man
uscr
ipt
A
uthor Man
uscr
ipt
A
uthor Man
uscr
ipt
Table 2
Gay app use information and behaviors of gay app users in China (N=824).
Variables Frequency Percent
Found partners through traditional internet site in the last six months
Yes 337 40.9
No 487 59.1
Found partners in person at venues in the last six months
Yes 72 8.7
No 752 91.3
Time since started to use gay app < 6 months 137 16.6
6 months- 1 year 197 23.9
1–3 years 398 48.3
> 3 years 92 11.2
Number of sex partners found through gay app in the last 6 months
1 224 27.2
2 to 3 334 40.5
4 to 6 122 14.8
Above six 144 17.5
Number of receptive anal sex acts with partners met through gay app in the last six months
0 to 5 629 76.3
6 to 10 107 13.0
11 to 20 45 5.5
above 20 43 5.2
Number of insertive anal sex acts with partners met through gay app in the past six months
0 to 5 614 74.5
6 to 10 128 15.5
11 to 20 44 5.4
Above 20 38 4.6
Time duration between meeting the last sex partner through a gay app and meeting in person
< 1 hour 75 9.1
1–24 hours 225 27.3
2–7 days 317 38.5
2–3 weeks 87 10.6
> 3 weeks 120 14.6
Place had sex with the last partner met through gay app in the last six months
Home 345 41.9
Hotel 398 48.3
Venues 81 9.8
Used condom during last anal sex with the last partner met through gay app
Yes 527 74.7
No 179 25.4
Negotiated about condom use with the last gay app partner before met in person
Yes 486 59.0
No 338 41.0
Negotiated about condom use in person with the last gay app partner*
Yes 109 32.3
A
uthor Man
uscr
ipt
A
uthor Man
uscr
ipt
A
uthor Man
uscr
ipt
A
uthor Man
uscr
ipt
Variables Frequency Percent
Asked for HIV status of the last gay app partner before met in person
Yes 274 33.3
No 550 66.7
A
uthor Man
uscr
ipt
A
uthor Man
uscr
ipt
A
uthor Man
uscr
ipt
A
uthor Man
uscr
ipt
T ab le 3 Factors correlated with g
ay app use among MSM in China, 2014 (N=1424)
V ariables Crude OR 95% CI Adjusted OR € 95% CI Curr ently ha v
e a main
sexual partner No Ref Ref Y es 1.11 0.90,1.37 1.15 0.92,1.44 Ev
er engaged in v
aginal or
anal sex with w
omen Y es Ref Ref No 1.85 1.47,2.32 1.49 1.12,1.96
Engaged in condomless sex with w
omen in the last
six months No Ref Ref Y es 0.74 0.50,1.09 0.82 0.53,1.26
Engaged in condomless anal sex with last male partner in the last six months
No Ref Ref Y es 1.31 1.04,1.66 1.52 1.19,1.94
Engaged in gr
oup sex in the
last 12 months
No Ref Ref Y es 1.32 0.92,1.89 1.49 1.02,2.18
Engaged in commer
cial sex
in the last 12 months
No Ref Ref Y es 1.35 0.85,2.16 1.38 0.85,2.23 Self-r
eported HIV status
Ne
g
ati
v
e or not
sure Ref Ref Positi v e 0.60 0.36, 0.97 0.67 0.40, 1.11 Sexual Orientation Bise xual Ref Ref Homose xual 1.44 1.14,1.82 1.30 1.01,1.66
A
uthor Man
uscr
ipt
A
uthor Man
uscr
ipt
A
uthor Man
uscr
ipt
A
uthor Man
uscr
ipt
T ab le 4 Factors correlated with condomless anal intercourse with the last g
ay app partner among MSM and in China, 2014 (N=824)
Crude OR 95% CI Adjusted OR € 95% CI T
ime started to use gay app
> 3 years
Ref
Ref
< 6 months
1.02
0.53,1.99
0.85
0.42,1.68
6 –12 months
1.08 0.59,2.00 0.91 0.48,1.72 1–3 years 0.99 0.57,1.74 0.91 0.51,1.62
> 3 years
Ref
Ref
Number of sex partners f
ound
thr
ough a gay app in the last 6
months
1
Ref
Ref
2 to 3
0.86
0.57,1.31
0.84
0.55,1.29
4 to 6
0.61 0.34,1.08 0.60 0.33,1.09 Abo v e six 0.90 0.54,1.48 0.95 0.57,1.58
Number of r
ecepti
v
e anal sex acts
with partners met thr
ough a gay app
in the last six months
0 to 5
Ref
Ref
6 to 10
1.13
0.68,1.85
1.14
0.69,1.90
11 to 20
0.98 0.47,2.06 0.97 0.46,2.06 Abo v e 20 2.14 1.12,4.09 2.49 1.27,4.87
Number of inserti
v
e anal sex acts
with partners met thr
ough a gay app
in the last six months
0 to 5
Ref
Ref
6 to 10
0.77
0.47,1.27
0.80
0.48,1.34
11 to 20
1.76 0.88,3.50 1.70 0.84,3.47 Abo v e 20 1.56 0.78,3.15 1.86 0.89,3.87 T
ime duration between met the last
sex partner thr
ough a gay app and
met in person
> 3 weeks
Ref
Ref
< 1 hour
0.70 0.33,1.51 0.73 0.33,1.60 1–24 hours 0.86 0.50,1.48 0.84 0.48,1.46 2–7 days 1.03 0.62,1.72 1.04 0.62,1.75 2–3 weeks 0.88 0.45,1.75 0.88 0.44,1.77
Place had sex with the last gay app partner
A
uthor Man
uscr
ipt
A
uthor Man
uscr
ipt
A
uthor Man
uscr
ipt
A
uthor Man
uscr
ipt
Crude OR
95% CI
Adjusted OR
€
95% CI
Negotiated about condom use with the last gay app partner bef
or
e met
in person
Y
es
Ref
Ref
No
1.85
1.32,2.61
1.83
1.29,2.60
Negotiated about condom use with the last gay app partner after meeting in person
Y
es
Ref
Ref
No
0.87
0.61,1.24
0.84
0.58,1.21
Ask
ed f
or HIV status of the last gay
app partner bef
or
e met in person
Y
es
Ref
Ref
No
1.00
0.51,1.94
0.98
0.50,1.93
Self-r
eported HIV status
Ne
g
ati
v
e or not
sure
Ref
Ref
Positi
v
e
2.27
0.78, 6.60
2.22
0.76, 6,52
A
uthor Man
uscr
ipt
A
uthor Man
uscr
ipt
A
uthor Man
uscr
ipt
A
uthor Man
uscr
ipt
T
ab
le 5
Se
x patterns with last app partners among Chinese MSM who met last g
ay app partner within and o
v
er one week after met through g
ay app in last six
months, 2014 (N=824)
Duration between f
irst met thr
ough gay app and in
person
P
One week or less
Mor
e than one week
Fr
equenc
y
P
er
centage
Fr
equenc
y
P
er
centage
Number of gay app partners in last six months
<2
134
21.7
90
43.5
<0.001
2 or more
483
78.3
117
56.5
Negotiated about condom use with the last gay app partner bef
or
e met in person
Y
es
356
57.7
130
62.8
0.22
No
261
42.3
77
37.2
Used condom during last anal sex with the last partner met thr
ough gay app
Y
es
394
74.8
133
74.3
0.92
No
133
25.2
46
25.7
Ask
ed f
or HIV status of the last
gay app partner bef
or
e met in
person
Y
es
175
28.4
99
47.8
<0.001
No
442
71.6
108
52.2
Place had sex with the last gay app partner
Hotel
252
40.8
93
44.9
0.055
Home
299
48.5
99
47.8
V
enues
66
10.7
15
